Provider Demographics
NPI:1861941742
Name:KING, WENDI (LMT, REFLEXOLOGIST)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMT, REFLEXOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 COLOROW RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9510
Mailing Address - Country:US
Mailing Address - Phone:720-273-5540
Mailing Address - Fax:
Practice Address - Street 1:10600 W ALAMEDA AVE
Practice Address - Street 2:#108
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2601
Practice Address - Country:US
Practice Address - Phone:303-986-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist